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Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

Identifieur interne : 000713 ( PubMed/Curation ); précédent : 000712; suivant : 000714

Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

Auteurs : Michael Schomaker [Afrique du Sud] ; Valeriane Leroy [France] ; Tom Wolfs [Pays-Bas] ; Karl-Günter Technau [Afrique du Sud] ; Lorna Renner [Ghana] ; Ali Judd [Royaume-Uni] ; Shobna Sawry [Afrique du Sud] ; Madeleine Amorissani-Folquet [Côte d'Ivoire] ; Antoni Noguera-Julian [Espagne] ; Frank Tanser [Afrique du Sud] ; François Eboua [Côte d'Ivoire] ; Maria Luisa Navarro [Espagne] ; Cleophas Chimbetete [Zimbabwe] ; Clarisse Amani-Bosse [Côte d'Ivoire] ; Josiane Warszawski [France] ; Sam Phiri [Malawi] ; Sylvie N'Gbeche [Côte d'Ivoire] ; Vivian Cox [Afrique du Sud] ; Fla Koueta [Burkina Faso] ; Janet Giddy [Afrique du Sud] ; Haby Sygnaté-Sy [Sénégal] ; Dorthe Raben [Danemark] ; Geneviève Chêne [France] ; Mary-Ann Davies [Afrique du Sud]

Source :

RBID : pubmed:27342220

Abstract

There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents.

DOI: 10.1093/ije/dyw097
PubMed: 27342220

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pubmed:27342220

Le document en format XML

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<name sortKey="Noguera Julian, Antoni" sort="Noguera Julian, Antoni" uniqKey="Noguera Julian A" first="Antoni" last="Noguera-Julian">Antoni Noguera-Julian</name>
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<name sortKey="Chimbetete, Cleophas" sort="Chimbetete, Cleophas" uniqKey="Chimbetete C" first="Cleophas" last="Chimbetete">Cleophas Chimbetete</name>
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<name sortKey="Cox, Vivian" sort="Cox, Vivian" uniqKey="Cox V" first="Vivian" last="Cox">Vivian Cox</name>
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<name sortKey="Koueta, Fla" sort="Koueta, Fla" uniqKey="Koueta F" first="Fla" last="Koueta">Fla Koueta</name>
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<nlm:affiliation>Charles de Gaulle University Hospital, Ouagadougou, Burkina Faso.</nlm:affiliation>
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<name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name>
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<nlm:affiliation>Albert Royer Hospital, Dakar, Senegal.</nlm:affiliation>
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<name sortKey="Raben, Dorthe" sort="Raben, Dorthe" uniqKey="Raben D" first="Dorthe" last="Raben">Dorthe Raben</name>
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<nlm:affiliation>Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.</nlm:affiliation>
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<name sortKey="Davies, Mary Ann" sort="Davies, Mary Ann" uniqKey="Davies M" first="Mary-Ann" last="Davies">Mary-Ann Davies</name>
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<title xml:lang="en">Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.</title>
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<name sortKey="Schomaker, Michael" sort="Schomaker, Michael" uniqKey="Schomaker M" first="Michael" last="Schomaker">Michael Schomaker</name>
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<nlm:affiliation>Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.</nlm:affiliation>
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<nlm:affiliation>Inserm, U1027, Université Paul Sabatier Toulouse 3 Toulouse, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
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<nlm:affiliation>Children's Hospital/UMCU, Department of Infectious Diseases, Utrecht, The Netherlands.</nlm:affiliation>
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<name sortKey="Technau, Karl Gunter" sort="Technau, Karl Gunter" uniqKey="Technau K" first="Karl-Günter" last="Technau">Karl-Günter Technau</name>
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<nlm:affiliation>Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation>
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<name sortKey="Judd, Ali" sort="Judd, Ali" uniqKey="Judd A" first="Ali" last="Judd">Ali Judd</name>
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<name sortKey="Sawry, Shobna" sort="Sawry, Shobna" uniqKey="Sawry S" first="Shobna" last="Sawry">Shobna Sawry</name>
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<nlm:affiliation>University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.</nlm:affiliation>
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<name sortKey="Amorissani Folquet, Madeleine" sort="Amorissani Folquet, Madeleine" uniqKey="Amorissani Folquet M" first="Madeleine" last="Amorissani-Folquet">Madeleine Amorissani-Folquet</name>
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<name sortKey="Noguera Julian, Antoni" sort="Noguera Julian, Antoni" uniqKey="Noguera Julian A" first="Antoni" last="Noguera-Julian">Antoni Noguera-Julian</name>
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<nlm:affiliation>Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.</nlm:affiliation>
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<name sortKey="Tanser, Frank" sort="Tanser, Frank" uniqKey="Tanser F" first="Frank" last="Tanser">Frank Tanser</name>
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<name sortKey="Eboua, Francois" sort="Eboua, Francois" uniqKey="Eboua F" first="François" last="Eboua">François Eboua</name>
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<nlm:affiliation>Yopougon University Hospital, Abidjan, Côte d'Ivoire.</nlm:affiliation>
<country xml:lang="fr">Côte d'Ivoire</country>
<wicri:regionArea>Yopougon University Hospital, Abidjan</wicri:regionArea>
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<name sortKey="Navarro, Maria Luisa" sort="Navarro, Maria Luisa" uniqKey="Navarro M" first="Maria Luisa" last="Navarro">Maria Luisa Navarro</name>
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<nlm:affiliation>Hospital Gregorio Marañón, Madrid, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Hospital Gregorio Marañón, Madrid</wicri:regionArea>
</affiliation>
</author>
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<name sortKey="Chimbetete, Cleophas" sort="Chimbetete, Cleophas" uniqKey="Chimbetete C" first="Cleophas" last="Chimbetete">Cleophas Chimbetete</name>
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<nlm:affiliation>Newlands Clinic, Harare, Zimbabwe.</nlm:affiliation>
<country xml:lang="fr">Zimbabwe</country>
<wicri:regionArea>Newlands Clinic, Harare</wicri:regionArea>
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</author>
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<name sortKey="Amani Bosse, Clarisse" sort="Amani Bosse, Clarisse" uniqKey="Amani Bosse C" first="Clarisse" last="Amani-Bosse">Clarisse Amani-Bosse</name>
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<nlm:affiliation>MTCT-Plus Center, Abidjan, Côte d'Ivoire.</nlm:affiliation>
<country xml:lang="fr">Côte d'Ivoire</country>
<wicri:regionArea>MTCT-Plus Center, Abidjan</wicri:regionArea>
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</author>
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<name sortKey="Warszawski, Josiane" sort="Warszawski, Josiane" uniqKey="Warszawski J" first="Josiane" last="Warszawski">Josiane Warszawski</name>
<affiliation wicri:level="1">
<nlm:affiliation>Centre de recherche en épidémiologie et santé des populations, 1018 Inserm, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Centre de recherche en épidémiologie et santé des populations, 1018 Inserm</wicri:regionArea>
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</author>
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<name sortKey="Phiri, Sam" sort="Phiri, Sam" uniqKey="Phiri S" first="Sam" last="Phiri">Sam Phiri</name>
<affiliation wicri:level="1">
<nlm:affiliation>Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi.</nlm:affiliation>
<country xml:lang="fr">Malawi</country>
<wicri:regionArea>Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe</wicri:regionArea>
</affiliation>
</author>
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<name sortKey="N Gbeche, Sylvie" sort="N Gbeche, Sylvie" uniqKey="N Gbeche S" first="Sylvie" last="N'Gbeche">Sylvie N'Gbeche</name>
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<nlm:affiliation>Centre de Prise en Charge de Recherche et de Formation Enfants, Abidjan, Côte d'Ivoire.</nlm:affiliation>
<country xml:lang="fr">Côte d'Ivoire</country>
<wicri:regionArea>Centre de Prise en Charge de Recherche et de Formation Enfants, Abidjan</wicri:regionArea>
</affiliation>
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<name sortKey="Cox, Vivian" sort="Cox, Vivian" uniqKey="Cox V" first="Vivian" last="Cox">Vivian Cox</name>
<affiliation wicri:level="1">
<nlm:affiliation>Médecins Sans Frontiéres South Africa, Cape Town, South Africa.</nlm:affiliation>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Médecins Sans Frontiéres South Africa, Cape Town</wicri:regionArea>
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<name sortKey="Koueta, Fla" sort="Koueta, Fla" uniqKey="Koueta F" first="Fla" last="Koueta">Fla Koueta</name>
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<nlm:affiliation>Charles de Gaulle University Hospital, Ouagadougou, Burkina Faso.</nlm:affiliation>
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<wicri:regionArea>Charles de Gaulle University Hospital, Ouagadougou</wicri:regionArea>
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<name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name>
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<nlm:affiliation>Sinikithemba Clinic, McCord Hospital, Durban, South Africa.</nlm:affiliation>
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<name sortKey="Sygnate Sy, Haby" sort="Sygnate Sy, Haby" uniqKey="Sygnate Sy H" first="Haby" last="Sygnaté-Sy">Haby Sygnaté-Sy</name>
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<name sortKey="Raben, Dorthe" sort="Raben, Dorthe" uniqKey="Raben D" first="Dorthe" last="Raben">Dorthe Raben</name>
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<nlm:affiliation>Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.</nlm:affiliation>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen</wicri:regionArea>
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<name sortKey="Chene, Genevieve" sort="Chene, Genevieve" uniqKey="Chene G" first="Geneviève" last="Chêne">Geneviève Chêne</name>
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<nlm:affiliation>University of Bordeaux Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France.</nlm:affiliation>
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<author>
<name sortKey="Davies, Mary Ann" sort="Davies, Mary Ann" uniqKey="Davies M" first="Mary-Ann" last="Davies">Mary-Ann Davies</name>
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<series>
<title level="j">International journal of epidemiology</title>
<idno type="eISSN">1464-3685</idno>
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<date when="2017" type="published">2017</date>
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<front>
<div type="abstract" xml:lang="en">There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents.</div>
</front>
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<DateCreated>
<Year>2016</Year>
<Month>06</Month>
<Day>25</Day>
</DateCreated>
<DateRevised>
<Year>2017</Year>
<Month>09</Month>
<Day>02</Day>
</DateRevised>
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<Journal>
<ISSN IssnType="Electronic">1464-3685</ISSN>
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<Volume>46</Volume>
<Issue>2</Issue>
<PubDate>
<Year>2017</Year>
<Month>Apr</Month>
<Day>01</Day>
</PubDate>
</JournalIssue>
<Title>International journal of epidemiology</Title>
<ISOAbbreviation>Int J Epidemiol</ISOAbbreviation>
</Journal>
<ArticleTitle>Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.</ArticleTitle>
<Pagination>
<MedlinePgn>453-465</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1093/ije/dyw097</ELocationID>
<Abstract>
<AbstractText Label="Background" NlmCategory="UNASSIGNED">There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents.</AbstractText>
<AbstractText Label="Methods" NlmCategory="UNASSIGNED">A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula.</AbstractText>
<AbstractText Label="Results" NlmCategory="UNASSIGNED">Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ≥ 1 and < 5 years), 373 (172; 630) (≥ 5 and < 10 years) and 238 (88; 425) (≥ 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm 3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (≥ 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (≥ 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes.</AbstractText>
<AbstractText Label="Conclusions" NlmCategory="UNASSIGNED">Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive.</AbstractText>
</Abstract>
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<Author ValidYN="Y">
<LastName>Schomaker</LastName>
<ForeName>Michael</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Leroy</LastName>
<ForeName>Valeriane</ForeName>
<Initials>V</Initials>
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<Affiliation>Inserm, U1027, Université Paul Sabatier Toulouse 3 Toulouse, France.</Affiliation>
</AffiliationInfo>
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<LastName>Wolfs</LastName>
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<Initials>T</Initials>
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<Affiliation>Children's Hospital/UMCU, Department of Infectious Diseases, Utrecht, The Netherlands.</Affiliation>
</AffiliationInfo>
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<LastName>Technau</LastName>
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<Affiliation>Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
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</AffiliationInfo>
<AffiliationInfo>
<Affiliation>School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.</Affiliation>
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</AffiliationInfo>
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<ForeName>Clarisse</ForeName>
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<Affiliation>INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France.</Affiliation>
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<AffiliationInfo>
<Affiliation>CHU de Bordeaux, Pôle de santé publique, Service d information médicale, F-33000 Bordeaux, France.</Affiliation>
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<Author ValidYN="Y">
<LastName>Davies</LastName>
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<Affiliation>Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.</Affiliation>
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<Author ValidYN="Y">
<CollectiveName>IeDEA West and Southern Africa regional collaborations and COHERE in EuroCoord</CollectiveName>
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<Language>eng</Language>
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<Grant>
<GrantID>MRC_MC_UU_12023/17</GrantID>
<Agency>Medical Research Council</Agency>
<Country>United Kingdom</Country>
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<Grant>
<GrantID>U01 AI069924</GrantID>
<Acronym>AI</Acronym>
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<Keyword MajorTopicYN="N">Antiretroviral treatment</Keyword>
<Keyword MajorTopicYN="N">causal inference</Keyword>
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<Keyword MajorTopicYN="N">paediatrics</Keyword>
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